Journal article
Hypotension following patent ductus arteriosus ligation: the role of adrenal hormones
The Journal of pediatrics, Vol.164(6), pp.1449-1455.e1
06/2014
DOI: 10.1016/j.jpeds.2014.01.058
PMCID: PMC4035426
PMID: 24636853
Abstract
To test the hypothesis that an impaired adrenal response to stress might play a role in the hypotension that follows patent ductus arteriosus (PDA) ligation.
We performed a multicenter study of infants born at <32 weeks' gestation who were about to undergo PDA ligation. Serum adrenal steroids were measured 3 times: before and after a cosyntropin (1.0 μg/kg) stimulation test (performed before the ligation), and at 10-12 hours after the ligation. A standardized approach for diagnosis and treatment of postoperative hypotension was followed at each site. A modified inotrope score (1 × dopamine [μg/kg/min] + 1 × dobutamine) was used to monitor the catecholamine support an infant received. Infants were considered to have catecholamine-resistant hypotension if their greatest inotrope score was >15.
Of 95 infants enrolled, 43 (45%) developed hypotension and 14 (15%) developed catecholamine-resistant hypotension. Low postoperative cortisol levels were not associated with the overall incidence of hypotension after ligation. However, low cortisol levels were associated with the refractoriness of the hypotension to catecholamine treatment. In a multivariate analysis: the OR for developing catecholamine-resistant hypotension was OR 36.6, 95% CI 2.8-476, P = .006. Low cortisol levels (in infants with catecholamine-resistant hypotension) were not attributable to adrenal immaturity or impairment; their cortisol precursor concentrations were either low or unchanged, and their response to cosyntropin was similar to infants without catecholamine-resistant hypotension.
Infants with low cortisol concentrations after PDA ligation are likely to develop postoperative catecholamine-resistant hypotension. We speculate that decreased adrenal stimulation, rather than an impaired adrenal response to stimulation, may account for the decreased production.
Details
- Title: Subtitle
- Hypotension following patent ductus arteriosus ligation: the role of adrenal hormones
- Creators
- Ronald I Clyman - University of California, San FranciscoAndrea Wickremasinghe - University of California, San FranciscoT Allen Merritt - Loma Linda UniversityTabitha Solomon - Loma Linda UniversityPatrick McNamara - University of TorontoAmish Jain - University of TorontoJaideep Singh - University of ChicagoAlison Chu - University of ChicagoShahab Noori - University of OklahomaKrishnamurthy Sekar - University of OklahomaPascal M Lavoie - Children's & Women's Health Centre of British ColumbiaJoshua T Attridge - University of VirginiaJonathan R Swanson - University of VirginiaMaria Gillam-Krakauer - Vanderbilt UniversityJeff Reese - Vanderbilt UniversitySara DeMauro - University of PennsylvaniaBrenda Poindexter - Indiana University – Purdue University IndianapolisSue Aucott - Johns Hopkins UniversityMonique Satpute - Johns Hopkins UniversityErika Fernandez - University of New MexicoRichard J Auchus - University of Michigan–Ann ArborPatent Ductus Arteriosus Ligation/Hypotension Trial Investigators
- Resource Type
- Journal article
- Publication Details
- The Journal of pediatrics, Vol.164(6), pp.1449-1455.e1
- DOI
- 10.1016/j.jpeds.2014.01.058
- PMID
- 24636853
- PMCID
- PMC4035426
- ISSN
- 0022-3476
- eISSN
- 1097-6833
- Grant note
- U24 DK097153 / NIDDK NIH HHS UL1 RR024975 / NCRR NIH HHS UL1 TR000004 / NCATS NIH HHS UL 1 TR000004 / NCATS NIH HHS T32 HD071860 / NICHD NIH HHS HL109199 / NHLBI NIH HHS U24DK097153 / NIDDK NIH HHS UL1 TR000445 / NCATS NIH HHS R01 HL109199 / NHLBI NIH HHS DK089503 / NIDDK NIH HHS P30 DK089503 / NIDDK NIH HHS
- Language
- English
- Date published
- 06/2014
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology; Internal Medicine
- Record Identifier
- 9984354119002771
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